Resuscitative endovascular balloon occlusion of the aorta in combat and austere environments

Non-compressible torso hemorrhage (NCTH) is a leading cause of preventable death in austere environments. Extended evacuation times prioritize far-forward hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) preserves proximal perfusion, shifting from specialized centers to prehospital combat settings.

To investigate the feasibility, safety, and clinical outcomes of REBOA for NCTH in combat and austere environments.

A PRISMA-ScR-guided scoping review searched five databases, with reference-list screening of included studies and key reviews, of humans receiving REBOA for NCTH in combat, prehospital, or austere environments. Two independent reviewers extracted patient characteristics, procedural parameters, and clinical outcomes. Quality was assessed via Joanna Briggs Institute tools and the Newcastle-Ottawa Scale.

From 1138 records, 8 studies, met criteria: 35 individually reported cases and 15 eligible cases from one registry cohort, of 50. Because the registry reported aggregate data only, all denominators below refer to the 35 individually reported cases. Casualties were predominantly young men in severe hemorrhagic shock after penetrating or blast injury. Access was via the common femoral artery, percutaneous in 23 of 35 (65.7%), with the balloon in zone 1 in 31 of 35 (88.6%). Survival to transfer or discharge was 91.4% (32 of 35); crude mortality was 8.6% (3 of 35). Complications were access-site thrombosis or limb ischemia in 4 of 35 (11.4%), one balloon rupture, and one reperfusion-related acute kidney injury.

REBOA has been utilized in select combat and austere casualties, demonstrating hemodynamic improvement. However, this uncontrolled evidence precludes conclusions regarding efficacy or superiority, thereby not supporting its routine clinical deployment.